Align and Smile Limited

We carried out this unannounced inspection on 19 September 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was providing well-led care in accordance with the relevant regulations.

Background

Align and Smile is in the London Borough of Tower Hamlets and provides NHS and private treatment to adults and children.

There is level access for people who use wheelchairs and those with pushchairs. Pay and display parking spaces are available near the practice.

The dental team includes five dentists, two orthodontist (one of whom is the principal dentist), one endodontist, one periodontist, four dental nurses, one dental hygienist, three dental hygiene therapists, three receptionists and an administrator. The practice has five treatment rooms.

The practice is owned by a company and as a condition of registration must have a person registered with the Care Quality Commission as the registered manager. Registered managers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run. The registered manager at Align and Smile Limited is the principal dentist.

On the day of inspection we spoke with three patients.

During the inspection we spoke with a dentist and the principal dentist, a dental nurse, the dental hygienist, and the administrator. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday - Thursday 9.am - 7.30pm

Friday – 9.am – 5.pm

Our key findings were:

• The practice appeared clean and well maintained.
• The provider had infection control procedures which reflected published guidance.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had systems to help them manage risk to patients and staff.
• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children.
• The provider had thorough staff recruitment procedures.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The provider was providing preventive care and supporting patients to ensure better oral health.
• The appointment system met patients’ needs.
• The practice had effective leadership and culture of continuous improvement.
• Staff felt involved and supported and worked well as a team.
• The practice asked staff and patients for feedback about the services they provided.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.

There were areas where the provider could make improvements. They should:

Review stocks of medicines and equipment and the practice's system for identifying, disposing and replenishing of out-of-date stock.

Review staff training to ensure that all the staff have received training, to an appropriate level, in the safeguarding of children and vulnerable adults.

Review the practice’s systems for assessing and monitoring risks in relation to fire and legionella. In particular, review the fire risk assessment regularly. Also, ensure that any recommendations identified on the legionella risk assessment are actioned and documented as completed.

Review the practice’s systems for assessing, monitoring and mitigating the various risks arising from when the dental hygienists work without chairside support.

Review the practice's protocols and procedures for the use of X-ray equipment in compliance with The Ionising Radiations Regulations 2017 and Ionising Radiation (Medical Exposure) Regulations 2017 and taking into account the guidance for Dental Practitioners on the Safe Use of X-ray Equipment.